Using Participatory Research to Build an Effective Type 2 Diabetes Intervention: The Process of Advocacy Among Female Hispanic Farmworkers and Their Families in Southeast Idaho

Abstract

The Formando Nuestro Futuro/Shaping our Future project (herewith, Formando) is a community-based participative research (CBPR) focused on type 2 diabetes. It was conceptualized and designed by a team of university-based researchers and community health workers (promotores). This article describes the process of establishing a CBPR project such as Formando and the most current results from that project. The Formando project is an example of health-focused advocacy with the Mexican agricultural workers in Southeast (SE) Idaho. To date, 172 qualitative interviews on participants' knowledge about type 2 diabetes have been carried out with farmworker women and their families. Biometric data (heights, weights, blood pressures and fasting blood glucoses) were obtained from participants. Fieldnotes, focus group discussions and key informants were used to triangulate findings. Significant quantitative findings include that age was significantly associated with Body Mass Index (BMI) (p < 0.001, Spearman Correlation < 0.001) and with elevated fasting blood glucose (p < 0.001, Spearman Correlation < 0.001). The qualitative interviews were thematically analyzed. Key themes associated with type 2 diabetes in this community were the connection between thinness and vanity, dieting and starvation and the onset of diabetes as a result of, what social scientists call, structural violence within the immigrants' daily lives. We conclude that long-term commitment to using the CBPR approach in these Mexican agricultural communities is an effective way to engage in health research and to establish real and meaningful dialogue with community members.

Use of the Transformative Framework in Mixed Methods Studies

“…Although these surveys were typically filled out by respondents, the study by Hollingsworth (2004) collected survey data using structured interviews. The most unique approach among quantitative data-collection techniques was that of Cartwright et al (2006), who used physical measures of glucose and body mass index (BMI) in their study of Hispanic female farm workers with type 2 diabetes. Rather than collecting quantitative data, Tolman and Szalacha (1999) quantified interview data for the quantitative portion of their data.…”

“…In these articles, one way in which researchers accomplished this goal was by aligning themselves with communitybased organizations. For instance, Cartwright et al (2006) worked closely with the Hispanic Health Projects (HHP), a community-based organization dedicated to promoting social justice at individual and systemic levels. The research conducted through HHP served to raise awareness and generate dialogue about social issues pertinent to the community.…”

“…Cartwright et al (2006) were one example. The authors discussed human rights but did not elaborate on how that perspective fits into their study.…”

“…Six articles discussed issues of diversity or oppression in their literature reviews but varied in the type of literature they discussed. Cartwright et al (2006) summarized the diabetes literature to provide an example of how Mexican immigrants were disenfranchised in Anglo society. Freeman (2000) discussed the family therapy literature to highlight its feminist-informed components.…”

“…A total of 3 of the 13 studies addressed how data collection and outcomes benefited the community. Cartwright et al (2006) attempted to share the findings with participants as the study progressed: "Formando was conceptualized with the idea of sharing the findings with the participants as the study progressed, as well as through addressing participants' questions during the process" (p. 100). Referrals were another source of reciprocity.…”